Hello, I was thinking about the best way for prisoners to rehabilitate while serving time, and I thought seeing a therapist one week and group therapy another week would be a good idea. Do you agree? Is it ok if it’s different psychologists or should it have to be the same person both times? (From Argentina)

A: Excellent question. I’d recommend an assessment initially to determine if an inmate is ready to use individual therapy as part of their rehabilitation. I do not think it is a good idea for everyone to be offered it — but rather selectively using it to help those who will benefit most from it most. As far as group therapy is concerned I would only offer this to those who have done well in individual therapy. This will maximize the their use of group to re-enter society.

From El Salvador: Hi, im 26 years old, last year i graduated from college and started working in a small company, since the end of last year i’ve been having a tough time with how i feel.

I always end up feeling like im not enough, in my job, for my family, and specially for the people that are close to me. Since March of this year i’ve been doing the Mood tracker quiz of psychcentral almoste every day. It always shows depressed as a significant mood or a mood of concern, the lowest score being 20 one day. I have not been diagnosed with depression or any other dissorder. Is the mood tracker enough reason to look for professional help? Will i be diagnosed with depression?

Thank you for your help.

A: The simple answer to your question is “no.” Repeatedly doing the same quiz can result in answers that are influenced by your own projections. But — (this is a big “but”) the fact that you are constantly checking yourself tells me that you already know that you do need to see a professional for a professional evaluation.

I can’t make a diagnosis on the basis of a letter. I can tell you that it is possible you are depressed. But it’s also possible that you have issues of self-esteem; that you have expectations for yourself that you are afraid you can’t reach or that there are family expectations that you are conflicted about reaching — to name only a few possibilities. A mental health counselor can help you sort out your issues and decide what kind of support and encouragement would be helpful.

I was babysitting a child (girl) who was about 6-8 years old. We were talking and she told me that she did not like playing with a specific friend, who was also a girl, also her age. She told me that they would sometimes go into her bedroom and close the door and she would lie down on her bed and her friend would be the doctor. She seemed uncomfortable and did not want to speak about it, although did not seem to understand why. I asked her why she didn’t tell her friend no. She told me that her friend did not listen to her, and made all the rules when they played together. They are neighbors, so they play together very often. The girl that I babysit is very timid and doesn’t know how to stand up for herself, and the neighbor, (who I met,) is very aggressive. I do not know if this is considered abuse, as they are both girls, both the same age. Is this normal childhood curiosity? And if it is abuse, and has been going on for a little while, should this girl be in therapy?

A. “Playing doctor” and body exploration is normal among young children. Curiosity is developmentally normal at this age, but there are several red flags that might suggest that this is not developmentally-appropriate behavior. The potential victim is uncomfortable and feels forced into this “game.” The potential offending child does not take no for an answer and is also quite aggressive. Those are suspicious signs that could indicate that this is abnormal and inappropriate.

You should immediately bring this information to the attention of her parents. If necessary, you could also contact child protective services or local law enforcement. The investigating professionals can assess the situation and determine if further action is warranted. Thank you for your question. Please take care.

I don’t know what’s wrong with me. My parents are divorced. I moved to this country. My brother moved back to England to be with my dad. My mum and step-dad were alcoholics and my step-brothers were mean. I think I might have abandonment PTSD, but I have no abandonment issues. I was technically abused but it was neglect mostly and doesn’t feel worthy of being called abuse. My mother is kind of a child, I’ve spent most of my life since I was 10 or 13 looking after her, especially after her second divorce. In which I sometimes had to put her to bed. I was often a mediator between her and my stepfather. The pair cried to me rather often. When they divorced, my step dad told me he’d still be here for me if I needed him, but I recently tried to reconnect with him to no avail. I understand that “I’m here for you” is never a sentence for the recipient but rather the speaker, to make them feel good. I understand that people are self-centered and small-minded. I had a history of instigating chaos by constantly breaking the law, trespassing, stealing, vandalism. I’m well behaved now, but I still have memories and old pains of my youth. All of the times people said they’d be there for me. My attempted suicide. My mother’s attempted suicide. The time when I was dragged up the stairs by my hair. The rumors in middle school that lead to people fearing me for no reason, and the times that I let the rumors change me, and I hurt people. The boyfriend who gunned me down with a bb gun, almost blinding me, and on a separate occasion (after breaking up) the time that he threw a chair at me. My best friend who left me because I’m “childish, spend too much time with my boyfriend, and disrespect my mother”. My mother who actually assaulted my boyfriend once. Man, she would get so out of her face sometimes that she… A couple of times back at my stepdads, she would barge into my room (she did that a lot) and throw suitcases on the floor, demanding that I pack so that we’d leave, but I, a 13-year-old, knew better than to get in the car with a drunk. On many occasions, I barricaded myself in my room, hid in my closet, or on the roof. I sometimes went without food because my step brothers ate everything. I had my own secret pantry of snacks and I was still underweight. I don’t know, I’m just throwing out all the information I think could use some help.

A: It is time to become more self-sufficient by getting a job and planning on moving out. At 20 years old you need to have some plans and a direction for your life that doesn’t involve your highly dysfunctional family. I would also highly recommend some therapy as you sort through your options and pull these plans together.

It might take you a while — even a year or so — but you need to have a plan to become more independent.

]]>43941How Do I Know if It Is Generalized Anxiety?http://psychcentral.com/ask-the-therapist/2016/12/07/how-do-i-know-if-it-is-generalized-anxiety/
Wed, 07 Dec 2016 12:30:26 +0000http://psychcentral.com/ask-the-therapist/?p=43303

From a teen in the U.S.: So here is my situation: I have anxiety for quite a few situations. It is not ONLY social situations or for a specific phobia. I have the typical anxiety symptoms (though mild in comparison to those who throw up, have panic attacks, etc) when I am
a) thinking about an impending social event/school event/ceremony where I will have to interact with someone other than my two best friends and my family/being there without them/arriving without them and being uncertain about little things such as where to sit
b) on my way to those events
c) during these events (unless I was super overreacting and I actually have fun)
d) when I think about storms
e) at doctors offices, esp before shots or blood pressure tests. I had my first and only panic attack when I was told I would be getting a shot I had not mentally prepared for
f) when I feel like a nuisance for employees at restaurants (my family is being slow, etc)
g) when I have to speak in front of people, any context
h) when I think about impending overwhelming things and what is due, like homework and fitting in work and applying for colleges (that one is pretty normal I think)
i) when my dad is late picking me up from an event or something, and it has gotten worse since I turned 16 because everyone around me leaves on their own terms. I sometimes just worry about being pitied or thought about in any sense, as I stick out as waiting, and sometimes I worry that my dad has gotten into an accident or something and I get really anxious
j) driving. everything about it. I cant.
k) the thought of making new friends/dating

there are honestly more. Anyway I can basically pinpoint where all my anxiety comes from. (also I am pretty sure a lot of it has to do with my insecurity) So is that still considered generalized? I also can push through these. I can’t and don’t let it paralyze me when I know it will be harmful to my future, like when I needed a job or I needed to be in leadership of a club so I could get into a college. But it still sucks. I just don’t know where I stand. Thank you if you can help.

A: Generalized anxiety means exactly that: The anxiety is generally there much of the time about many, many things. However, I can’t tell whether you have the normal anxieties of every person who is emerging into adulthood or whether you have a “disorder.” It’s important to make the distinction. What you need to do to help yourself depends on accurately understanding the problem.

Many many teens have the anxieties and concerns you listed. Many many teens are easily embarrassed (especially by family members), are uneasy socially and very concerned about how to fit in. If your worries are within the range of normal, the “treatment” is to watch and learn from others, to take your time when you are nervous, and to remember that this is all the sometimes uncomfortable part of growing up.

A disorder is more pervasive. People with GAD (Generalized Anxiety Disorder) worry excessively a good deal of the time. It interferes with their functioning in their schoolwork, jobs, and relationships. They are often irritable and depressed and sometimes are even suicidal. There are often physical symptoms as well, such as nausea, diarrhea or irritable bowel syndrome, headaches, sweating, maybe sleep disturbance.

If that is the case with you, you should see a professional mental health counselor for an evaluation. If diagnosed with GAD, treatment will include talk therapy to teach you skills for managing your anxiety and for becoming more self-confident. Sometimes a medication is also recommended.

I don’t know where to begin. It seems stupid just to come here and write about what’s wrong with me. Or what I think is wrong with me. All my problems seem made up by myself. I ocassionally feel depressed, but I don’t deserve to be depressed. I have everything in my life to be happy: family, some friends, upper middle class upbringing, material things. I feel guilty and ungrateful.

My anxiety doesn’t let me alone. I keep thinking of ridiculous problems just to have something interesting happening in my life, as I’m bored all the time. The knot in my throat doesn’t go away unless I bite my knuckles until I tear my skin. The thoughts in my head sometimes don’t go away unless I hit them hard enough to leave my head physically hurting, slightly inflamated. I like alcohol. Maybe a little too much. But I don’t drink often. Just a couple time a month, when my friends decide going drinking. You could say I’m a social drinker. I could buy it and drink on my own, but I know myself enough to know how obsessive I can be. I can easily become an alcoholic and this scares me. It scares me that one day I will decide to attempt to drown my nonexistent issues and won’t be able to stop from that day on.I destroy every good thing that happens in my life. A good relationship, an incredible scholarship opportunity… unconsciously I find a way to sabotage myself. I feel unworthy: people often say how amazing I am but I just can’t believe them because I know it isn’t true. Sometimes it feels as if they say those things out of pity. If something good is about to happen to me, I just can’t believe it until I’m actually living it. As if I can’t let myself have hope for fear of being hurt.I feel annoying and like a disturbance. This one used to be a bigger issue for me, but I’m working on it. Still, I can’t stop thinking that something is wrong with me. I see all kinds of people in relationships. People that are uglier, fatter, weirder, that seem less intelligent, successful. Everyone finds someone else, but me. Something must be seriously wrong with me to repel people like I do. Thus why I feel the way I just wrote about.

A. You have expressed three main cognitive errors that may be contributing to your distress. I will describe them below.

The first cognitive error is that you should not be depressed because you have material wealth. The implication is that wealth should make you happy. Of course you should appreciate your good fortune and your blessings but wealth does not equal happiness. Study after study shows that to be true.

There is no roadmap in life; for any of us. Many people feel lost. Each of us, rich or poor, has to find our own path. It’s easy to get off track and to become depressed, especially when lacking guidance and a strong mentor. Counseling could provide you with the necessary guidance and mentorship.

Depression is often the result of a lack of purpose in one’s life. In order to be happy we have to find meaning in life. That’s an overly simplistic view of depression but without that key element, many people, no matter their socioeconomic status, feel empty, sad and alone. The good news is that depression is a highly treatable condition.

The second cognitive error expressed in your question, is that everyone is in a relationship except for you. I believe that what you meant is that everyone else is happy except for you. That is a fallacy. People who are depressed often think that everyone is better off than they are. They are intimately familiar with their own pain and suffering but they do not perceive the pain and suffering of others. That’s largely because people don’t generally express their negative emotions in public or even to close friends. They think it will make them seem less likeable, less cool, and more needy. They suffer alone, in isolation, where there are no witnesses. Even though you can’t feel it or see it, many people are suffering. Life is challenging for most everyone.

The third cognitive error is that you should be able to solve your own problems. You didn’t say that directly but you implied it when you wrote that you have tried to help yourself and it has not worked. The disappointment has led you to feel like you have failed. That is common thinking about mental health.

People don’t believe that they should be able to treat their own physical health problems yet it’s common for them to think that they should be able to treat their own mental health problems. Mental health professionals undergo years of rigorous training to learn how to treat mental health problems. These are learned skills. You shouldn’t expect to be able to solve your own problems. No one should.

When you know that something is wrong, you should ask for help. You could greatly benefit from counseling. Counseling is an effective treatment for depression and many other emotional problems. Medication might also be helpful. I urge you to ask your parents to assist you in seeking treatment. That would be the right thing to do. Please take care.

I don’t think this is a major problem but at random when I look at someone or look at a picture my brain automatically comments on something about them. If I am looking at a woman that is obese my brain will think “Wow she is so fat, she should start going work out” or something along those lines and then I think to myself that what I just thought was really mean. Do i have a condition that I am unaware of or is this normal. This doesn’t happen with everyone I meet but it just randomly happens even when i’m with my friends sometimes I a mean comment pops up and it surprises me. I don’t have any tragic/traumatic past but when I was a kid and even now I have trouble going to sleep because I am always afraid of something fictional. Like when I was younger I was very afraid of Dracula coming into my room and sucking my blood so i would sleep facing up, without my neck showing. Or anytime I closed my eyes I would imagine something from a horror film and couldn’t go to sleep. Also my parents spanked me with a clothe hanger when I was younger, but not very often only when I was misbehaving. I don’t think my past has anything to do with it and was just curious if I had a condition. Thanks in advance.

A: Thank you for your question. I think both parts of your reaction — the mean part and the part that questions it — are well within the normal range of thought. The fact that you are noticing it is good as it will give you an opportunity to correct unwanted reactions and biases.

From England: Hi, I have always had a very difficult time maintaining relationships after suffering years of abuse from my father but physical and verbal, and verbally and emotionally from my mother. I have been diagnosed with complex PTSD, and I now have a partner of 8 months. My biggest fear is that because of my history I have picked a man that is like my father on a subconscious level. How do I know if this man is abusive or if this relationship is normal without any point of reference? He occasionally puts me down, and does some other insensitive and thoughtless things, but I don’t know where to draw the line. I don’t want to end up with an abusive partner, is there any guidelines for someone like me to use as a rule of thumb?

A: You’ve asked a very important question. Your challenge is to, on the one hand, take care of yourself by being aware of your potential for repeating bad experiences but, on the other hand, not to be so hyper-sensitive that you see abuse when someone is merely clumsy or having a bad day.

The best indication of someone’s character is how they have behaved in the past. Since you are in your late 20s, I’m going to guess your partner is as well. Chances are he has had other relationships. How he talks about and treats former partners is instructive. Does put them down? Does he blame them for whatever went wrong in relationships or does he take responsibility for his part in break ups? Does he generally treat women with respect and sensitivity? The measure of a man is not just how he treats you in the heady time of new romance but in how he treats and talks about the other women in his life (from the check out clerk in the grocery store, to his mom, to his former partners, etc.). If you pay attention to this, chances are you will get your answer.

Basically, I’ve come in search of help with anger management. I was raised with very strict, religious, over protective parents who constantly had violent arguments, taught me to shut down my emotions and to not express my feelings (at least not in healthy ways), taught me that the world is a dangerous, untrustworthy place, and that I cannot trust anyone. As a result, I have grown up to be very nervous, very shy, unable to trust others, unable to express love easily, unable to deal with negative thoughts or emotions in a productive fashion, afraid to be independent in the world, and constantly feel like I can’t make something successful of myself. I wasn’t always like this. I remember in my early childhood that I loved to socialize, explore the world, learn, I had dreams that I honestly thought I could reach. I was more positive, hopeful, and optimistic. Now, I feel as though all I ever feel is anger. I’m so restless. I want to do something, have fun, grow up , stop being so shy, and improve as a person, but, I don’t know where to start. And with my parents not permitting me to go out on my own, or even express my feelings to them without them thinking I’m possessed or something, I feel trapped.I’m not a bad kid. I’m sure of that. I mess up here and there but I really try. Ask anyone. I’ve been obedient, respectful, polite, patient for as long as I can remember, but, lately, only with my parents, have I been lashing out at. Of course, not physically, but I have been getting more violent recently. I’ve gotten into the habit of breaking things around me when I’m angry and just screaming and crying. It’s scaring me. I don’t want to hurt anyone. My parents have done so much for me, and I know they have tried their best at raising me, but, I can’t help but blame them for how I turned out and feel angry at them. Maybe it’s my fault and I’m too ashamed to accept that so I take it out on them? I just need guidance. I need a plan, a place to start. I hate this feeling of cluelessness as it makes me feel breathless and trapped. Thank you for listening to his wacky 16 year old rant.

A. I would not consider your question to be a “wacky…rant.” It is an expression of your feelings. It’s healthy to write when you are stressed. In fact, you should do it more often. When strong emotions arise write about them. Research shows that journaling is a healthy outlet for expressing strong emotions. It can also help to clarify your thinking, come to resolutions and move you past your problems. It’s a psychologically clarifying exercise that can provide a great deal of emotional relief.

Your feelings seem perfectly understandable given your family environment. You are developing your own ideas about yourself and the world, which are in conflict with those of your parents. That conflict is causing problems for you and in your emotional life. These types of conflicts are fairly normal during adolescence. In two years, you will be an adult and can live independently, should you choose to do so.

In the meantime, speak to the school guidance counselor or the school psychologist about these issues. Counseling could help you tremendously. You might consider showing this letter to your parents. They may be more open than you realize to your seeking mental health treatment. Maybe not, but it is something to consider.

Other ideas include finding alternative outlets for your strong emotions. These can include, exercise, yoga, meditation, volunteering or reading self-help or anger management workbooks. Some of my favorite workbooks are written by David Burns and there are many others. They can be purchased through Amazon or you might find them at your local library.

I want to be clear about the fact that mental health treatment would provide you with the greatest level of benefit but if it is not an option for you, some of the aforementioned ideas may be of assistance.

Finally, if you feel like you might hurt yourself or someone else, then it’s imperative that you call emergency services or go to the hospital. The staff can keep you safe and protect you from hurting yourself or someone else. Please take care.

From a teen in Ireland: My father, somewhat a former drunkard, beat my little brother and my older sister (and my mother) – but I strangely can’t recall him beating me. I am gay and I am quite certain my sister and I have developed BPD thanks to him, but that is not the problem. I don’t speak to my father, though we live under the same roof. He speaks more to my other siblings.

I have an aversion towards my father and he has one towards me. I remember very very little of my childhood and have a deep rooted feeling as of the past week that something is gravely wrong – that something I am worried could be sexual abuse. I have been plagued with problems and recently stumbled upon something to do with sexual abuse whilst looking for a solution to a problem I can’t disclose, though take my word that the problem in question could very well stem from abuse. My father talks to the rest of my family but not me at this point, though often times he overcompensates for meagre things towards me. This, and not hitting me, seems like guilt to me, but I am not sure.

My aversion extends to a discomfort around my father. This is the most credible ‘evidence’ to me. I cover up when he is around. I do not walk around him in any underwear or bare chested. He has been sexually suggestive in the past (touching of bottom ‘jokingly’) (perhaps this could be the aversion and not a more serious abuse?). I keep my front facing him at all times and consciously will not turn my back to him. I am not comfortable around him, simply put.

I don’t ask for a definitive answer for that’s not possible without the help of extensive therapy, this I know, but what I do ask for is your thoughts. I want to know how likely it sounds, because in all honesty I am not sure. I am a problematic person and this could very well explain my problems. I have not simply ticked off a list, though I do know some symptoms. I just would like thoughts. Is a deep rooted feeling a sign of a more serious subconscious aversion? Does there appear to be credibility to what I suggest but that I am paranoid?

Thank you.

A: As you pointed out, your question can’t be answered simply. It’s certainly possible there is a history of early abuse. It’s also possible that like many dads, your dad may be uncomfortable with your emergence as a sexual being. Many dads feel some attraction and pride in their kids at this stage, but their respect for the cultural taboos against acting on that attraction keeps everyone safe. Often the dads do some distancing during this time while their relationship with their kid transitions from dad-child to dad-young adult.

Even if you are not “out” to your dad, he may sense that your attraction is to men. He may feel some attraction to you that shames and alarms him so he keeps his distance. You may be picking up on his fears so respond by doing the same. These feelings are normal. Good boundaries keep everyone safe.

This is complicated stuff for many families. Therapy would likely help you answer your questions. I encourage you to give yourself some peace of mind by talking to a counselor.

You shared that there are many other distressing issues in your family. I hope family members are open to getting some family treatment so everyone, as individuals and as family members, can have a happier future.

I wish you well.
Dr. Marie

]]>43305Partner’s Aversion to Her Own Cat: What Does It Mean in Relation Other Issues?http://psychcentral.com/ask-the-therapist/2016/12/03/partners-aversion-to-her-own-cat-what-does-it-mean-in-relation-other-issues/
Sat, 03 Dec 2016 12:30:10 +0000http://psychcentral.com/ask-the-therapist/?p=43763

My partner has an aversion to her own cats want of attention. She gets highly annoyed when the cat seeks attention and cuddles. Her own expressions of annoyance include an analysis that the cat is ‘just greedy’ and is trying to ‘take from her’. She gets very annoyed and downright angry at times. My partner has a lot of childhood issues of abandonment which I think might be related to this. I had another partner previously who also had childhood trauma(rape)and had the same issues of detachment from her pets and annoyance when they sought attention. I’m trying to understand the intricate meaning behind this disconnect with animals so that I can understand the mentality behind my partners feelings/actions???

A. Only having a small amount of information about your partner is not enough to explain the meaning behind her behavior. Maybe it’s indicative of a psychological problem, but there may be no deep meaning behind it. It’s also possible that she doesn’t like cats or animals in general. There are many people who don’t like animals. They simply don’t want to interact with them and find them annoying. It could be as simple as her dislike for cats or animals in general.

It is odd that she has a cat when it seems like she’s not very fond of them. There are many questions that need to be asked, if you are to find the reasons for her behavior. A therapist would do exactly that. If you’re curious, you should ask her more. It might provide the answers you are looking for. Thanks for your question. Please take care.

From a teen in the UK: I’m in my last year of school, and I know its normal to feel stressed but I’m not sure if what i’m feeling is normal. I also have a history of self harm and feeling down for no reason and not being able to control it. I stopped self harming a few months ago and starting feeling really good, but I’ve started to feel unable to relax, always thinking about work, and I’ve started getting chest pains, and a worried feeling constantly. I’ve started having breakdowns and panic attacks and i’m unable to take my mind off my problems. I’ll get stressed over work even when i’ve done everything i needed to do, and I’ve started feeling down and crying for no reason. My hands get shaky, and I constantly feel tense and on edge. Is this normal for my last year of school, or do I have another problem worth addressing??

A: It’s absolutely normal to feel stressed about finishing school and launching into adult life. It is not normal to be so stressed about it that you have chest pains, breakdowns and panic attacks. Since you have a history of self-harm, I’m especially worried about you. I think it would be advisable for you to find a counselor to give you some support and coaching as you go through this challenging transition of life. You deserve to be able to celebrate finishing school instead of suffering through it.

I never thought it was a issue until I hit a breaking point from my Internship meeting. I was told that I’m not processing things (as he pointed at his head) at that moment I felt like I was retarded. That’s where I began to see a pattern from my previous jobs and through life. I would make a lot of mistakes when I am being told to do something. I’m not nervous, or deaf. I can hear, but when people talk to me I block out/they seem like they mumble rather than talking so I block out. It is troublesome because I have to repeat people all the time, and when I do managers shout at me and I hold back my feelings until I finish my shift which have nightmares about. I feel like I’m slow when doing a task. However it does not makes sentence because I have good grades and do all my homework and yet I can’t do what is asked to be done. I came to the point were I had to confess to my employer and my school, that I have problem and don’t know what it is. All I know that I can’t understand messages or phone calls (Even in high volume) , can’t follow instructions, I try to concentrate what people are saying but the words cant process in my freaking brain which makes me mad and helpless at myself that I can’t do anything right, it is very had to multitask, I sturred/can’t talk right. Even my family notice something was wrong with me when they talk to me because I always do the opposite of what they say. I always thought if I try harder it will be better, but with me my mistakes remind the same. To be honest my mind works differently when people talk to me I mix words up or numbers. I always have to solve what people say if I forget/block out, which makes them repeat themselves, I always compare myself with other girls and be like why can’t I get it like her, you know. As for right now, I am taking notes and writing what people say so I won’t get mix up, but sometimes that doesn’t work so I have show to them what I wrote down “what I think they said.” I cry a lot because this a problem that stops me from maturing and succeeding in my career. I don’t know what is holding me back mentally because it’s effecting me physically. I’m scared because I might not going to find a good job to provide for my family. My school also wants to know what is wrong because they know I’m doing great in school learning medical billing, but they are getting my reviews on what I can’t do which is frustrating.

A. This problem seems outside of your control. It does not seem as though you’re deliberately being defiant. I point that out because of the self-abusive tone of your letter. If a friend or a family member had this problem, would you be equally as harsh on them as you are being on yourself? It’s highly unlikely. You seem to be legitimately struggling with processing certain types of information. I understand your frustration but remember it’s not your fault.

It’s possible that your brain processes verbal information differently than written information. This is not to suggest that something’s wrong with you per se but that perhaps you have an undiagnosed learning disability. It could explain why you have been struggling for years.

One diagnostic possibility is an auditory processing disorder. Its symptoms include difficulty processing and remembering language-related tasks. There are other possibilities but an evaluation would be necessary to determine whether or not you have a learning disability.

If you do have a learning disability that substantially limits a major life activity (i.e. learning, thinking, reading, concentrating and communicating), then you are entitled (by federal law) to reasonable accommodations from both your school and employer. You should consult the disabilities service office on campus. They can provide you with more information about how to seek help for this potential issue.

You should also discuss your symptoms with your primary care physician who can provide you with the appropriate referrals. He or she might suggest undergoing a neuropsychological evaluation. This type of evaluation specifically assesses how your brain functions. Good luck. Please take care.

From a young teen: A few years ago, I went through several months of what I guess can only be described as really crippling depression. I was really stupid and slit my wrists and cried for no reason and forced myself to stop eating, that kind of stuff. What I remember really distinctly is assuming everyone else was going through the same thing. Anyway, when I kinda eased out of that phase, I became a lot happier and somewhere along the way I realized there was something different and bad about the way I’d been feeling for a couple of months (more like a year, really).

It’s coming back a little now, is the thing. Since around late last year, I’ve been feeling the same way on and off. I haven’t harmed myself, mostly because I know it’s idiotic, but also because I know I don’t want to kill myself. I want to die, though, a little bit.

Mostly the problem, though, has been this weird anxiety literally from the moment I wake up, something that feels a lot like schizophrenia except I know it’s me who’s yelling at me. The instant I wake up it’s like my whole body tightens with inexplicable anxiety. It doesn’t make any sense. And I yell at myself inside my head, I hear my voice inside my head yelling at myself and I hear my voice talking to me during the day.

Sometimes when I’m feeling very strange I can focus on the noise in my head and hear voices talking but I don’t know whose they are, and they’re not saying anything that makes any particular sense. That’s only happened a few times, though.

I don’t know if this matters, but I also have very loud music in my head, all the time. Another thing is that I am deeply distrustful of my friends, I don’t ever feel like they’ll understand what I have to say. I know it’s stupid. But I feel entirely disgusted at myself whenever I consider confiding in them.

I get frustrated very easily with myself, less so with other people, but that annoyance is still there. I’m obsessed with that which is obscure. I sometimes find it hard to concentrate on and finish things and get irrationally angry with myself because of this.

Anyway, yeah. Do I have something? What do I have? Should I see a therapist?

A: Yes. It would be a very good idea to see a therapist. One challenge of being an advice columnist is that a letter often doesn’t give me enough information for me to be helpful. A face to face therapist can ask follow up questions and get a more complete picture of what is going on. Sometimes just an initial interview is enough for someone like yourself to get reassurance and direction. Sometimes that interview results in some suggestions for further therapy.

One suggestion I have for you is this: Please keep a log of your sleep pattern for 2 weeks and take it with you to the first meeting with the therapist. Write down what time you go to bed, when you get up and if you get up during the night. I have a hunch that some of your distress may be related to a sleep disorder. That’s just a guess and I could be wrong, but it is something to check out.

I’ve told my mom that I have felt depressed since the 3rd grade. I used to fake sick just so I could stay in bed all day and I’m sad to say that I still do it even today. I’m in my second year of college, so I can’t really afford to pay for my own help. Anytime I mention it to my mother, I start to cry and all she says is “I know its hard but you’ll pull through.” I constantly have thoughts of suicide and have a history with self harm. My mom has no job as of the moment and my parents are divorced. My family has a history with depression, anxiety, and even bipolar disorder, yet my mom still doesn’t seem to want to believe that I could be depressed or have suicidal thoughts. I don’t know what to do and I feel trapped.

A. Virtually all colleges have free mental health services available to their students. You should utilize their help. College counseling centers typically offer free counseling. Most of the therapy that’s offered is short-term, but if longer-term treatment is needed you will likely be referred to the appropriate services. The cost of longer-term mental health treatment can depend on where you live, whether or not you have health insurance and your overall mental health needs. Many communities have free or low-cost services available.

Sometimes parents don’t know how to help their children. It can be easier to deny that a problem exists. Parents don’t want to think that anything is wrong with their children. It may be that your mother doesn’t know how to help you. It could also be that she thinks you are going through a “phase” and that whatever is wrong will work itself out. You do not need your mother’s approval in order to receive mental health treatment. The college counseling center treatment staff should be able to help you. I would strongly urge you to utilize their services.

If, for whatever reason, those services are not available to you and you feel as though you might harm yourself, then go to the emergency room or call emergency services. They can keep you safe and assist you in receiving mental health treatment. You are not trapped and help does exist. I hope that you’re able to receive the help that you desire. Please take care.